Severity of complications is associated with impaired health‐related quality of life in people with type 1 diabetes

TL;DR

People with type 1 diabetes who have more severe complications report lower quality of life, emphasizing the need for better complication prevention.

Contribution

This study demonstrates a strong inverse relationship between diabetes complication severity and health-related quality of life in adults with type 1 diabetes.

Findings

A one-step increase in complication severity was linked to a 1.5% decrease in overall quality of life scores.

Complication severity was inversely associated with most domains of both generic and diabetes-specific quality of life measures.

Over half of participants reported negative impacts on pain/discomfort and anxiety/depression domains.

Abstract

Health‐related quality of life (HRQoL) assessment is increasingly integrated into type 1 diabetes (T1D) monitoring to promote a holistic approach. To investigate HRQoL in adults with T1D and to assess the impact of the severity of complications on HRQoL.

This is a cross‐sectional analysis of baseline characteristics of adults living with T1D included in Société Francophone du Diabète – Cohorte Diabète de Type 1 (SFDT1), a French longitudinal cohort study. HRQoL was assessed using generic (EuroQol 5‐Dimensions 5‐Level questionnaire [EQ‐5D‐5L]) and diabetes‐specific (Audit of Diabetes‐Dependent Quality of Life) instruments. The severity of diabetes complications was measured using an adapted Diabetes Complication Score Index (DCSI) ranging from 0 to 14. We used multiple imputations to deal with missing data.

We included 1892 adults, 48% women, with a median (interquartile range [IQR]) age of 38 (28; 51) years. The mean overall EQ‐5D‐5L HRQoL score was 71.1 ± 17.7 (maximum 100), with the following number of participants negatively impacted for each domain: 271 (14%) for mobility, 94 (5%) for self‐care, 378 (19%) for usual activities, 853 (45%) for pain/discomfort and 983 (52%) for anxiety/depression. The median (IQR) DCSI was 1 (0; 2). In multivariable models, a one‐step increase in DCSI was associated with a 1.5% decrease in overall EQ‐5D‐5L HRQoL. DCSI was also inversely associated with all domains of the generic scale except anxiety/depression and 17 domains of the diabetes‐specific scale.

We observed an inverse association between the severity of complications and overall HRQoL and most of its dimensions. Our results highlight the need to reinforce the prevention of complications to improve the overall well‐being of people with T1D.

Figures